Department of Internal Medicine, 34973Korea University, Seoul, Korea.
Lupus. 2022 Oct;31(12):1468-1476. doi: 10.1177/09612033221122148. Epub 2022 Aug 19.
The safety of multitarget treatments is of concern. This study aimed to evaluate the effectiveness and safety of multitarget therapy as an induction treatment for lupus nephritis in comparison with monotherapy.
This study included randomized controlled trials (RCTs) that evaluated the effectiveness and safety of multitarget therapies, such as voclosporin+mycophenolate mofetil (MMF), tacrolimus+MMF, or belimumab+standard of care in comparison with MMF or cyclophosphamide (CYC) monotherapy for induction treatment of lupus nephritis. We performed a meta-analysis of the efficacy and safety of multitarget therapy as an induction treatment for lupus nephritis in comparison with monotherapy.
Six RCTs, including 1,437 participants, met the inclusion criteria. The complete remission rate was significantly higher in the multitarget therapy group than in the monotherapy group (odds ratio, 2.155; 95% CI, 1.695-2.739; < 0.001). Subgroup analysis revealed that the complete remission rate was significantly higher in both tacrolimus+MMF and voclosporin+MMF groups as well as the belimumab+standard of care (SOC) than in the monotherapy or SOC group. The incidence of adverse events did not differ between the multitarget therapy and monotherapy groups. However, cases of infection and pneumonia were numerically higher in the multitarget therapy group than in the monotherapy group. In addition, the incidence of menstrual disorder was significantly lower in the tacrolimus+MMF group than in the CYC group, whereas that of new-onset hypertension was considerably higher in the tacrolimus+MMF group than in the CYC group.
Multitarget therapy showed a higher complete remission rate than monotherapy; however, cases of infection and pneumonia were numerically more elevated in the multitarget therapy group than in the monotherapy group.
多靶点治疗的安全性令人担忧。本研究旨在评估多靶点治疗作为狼疮性肾炎诱导治疗与单药治疗相比的有效性和安全性。
本研究纳入了评估多靶点治疗（如 voclosporin+吗替麦考酚酯（MMF）、他克莫司+MMF 或 belimumab+标准治疗）与 MMF 或环磷酰胺（CYC）单药治疗狼疮性肾炎诱导治疗的疗效和安全性的随机对照试验（RCTs）。我们对多靶点治疗作为狼疮性肾炎诱导治疗与单药治疗相比的疗效和安全性进行了荟萃分析。
纳入的 6 项 RCT 共纳入 1437 名参与者。多靶点治疗组的完全缓解率显著高于单药治疗组（比值比，2.155；95%可信区间，1.695-2.739；<0.001）。亚组分析显示，他克莫司+MMF、voclosporin+MMF 和 belimumab+标准治疗（SOC）组的完全缓解率均显著高于单药或 SOC 组。多靶点治疗组与单药治疗组的不良事件发生率无差异。但多靶点治疗组感染和肺炎的发生率高于单药治疗组。此外，他克莫司+MMF 组的月经紊乱发生率显著低于 CYC 组，而他克莫司+MMF 组新发高血压的发生率明显高于 CYC 组。
多靶点治疗的完全缓解率高于单药治疗，但多靶点治疗组感染和肺炎的发生率高于单药治疗组。
